Risk Management: Health Services Orientation — Pointing People in the Right Direction

by Linda Ebner Erceg, R.N., M.S., P.H.N.

The summer camp season is imminent. Campers have enrolled, staff have been hired, and more supplies are arriving every day. As part of this "getting started" process, camp professionals are pulling out last year's orientation notes to shape this year's program.

We do well getting the largest portion of our staff, the counselors, oriented to their job, especially if we remember that orientation is simply that — getting people pointed in the right direction. It's not an end-point for staff formation, merely the launching point. But one aspect that often gets short-changed is the camp's health services. Orienting your camp community to the camp's health services is more than just talking about what goes on in the health center; it includes orienting staff and campers to the scope of services provided by camp, how to access those services, and the individual's role in health maintenance. It has distinctions based on the role of the person in camp: camper information varies from staff information, and what gets told to health center staff may well include items unnecessary for other staff. Preparing this segment of your orientation begins by reviewing the components from a management perspective.

Orienting Health Center Staff

These frontline people are often the folks who first spot "pink flags" of concern in the camp's health profile. Their ability to effectively and efficiently interface with other camp administrators is important. To do this, they need information that establishes the parameters of their work, and they probably need this before arriving at camp. Think about it. The camp's food service and health service are often the two functional areas of camp expected to deliver services way before the counselors begin taking care of campers. Many camp nurses tell stories about arriving at camp, responding to "What's your job here?" and immediately getting told about health concerns when the nurse hasn't even seen the health center! Seriously consider orienting this staff before the others. Points to talk about include:

Describe a typical camp day (not the campers' day nor a counselor's day). Share with them the scope of their tasks; time the health center opens; meal times; how and where routine medications are given; when the walk-around occurs (cabin checks); when the health center closes at night; personal time; and so forth. Talk about time management; acknowledge the frenzy of opening day but also explain the more usual and casual routine of camp.

Talk with these staff about the difference between caring for campers and caring for staff. It's easy for health center staff to treat people all the same; after all, the person came into the health center and asked for help. Care for campers often stems from a diligence based on in loco parentis care whereas staff are employees. Admitting a camper to the health center has a very different impact from admitting a staff member. Discuss this so everyone is on the proverbial "same page" regarding care plans.

Explain when staff and campers are screened and talk about how this happens. Use your protocol to discuss the scope of the screening process so health center staff, in their zeal to do a good job, don't assume you need full physicals. Remember to explain what they should do when someone presents a problem during that screening process — head lice is a great example.

If your camp hires health-care providers with different credentials, explain who supervises whom and discuss the implications of each credential's scope of practice at camp. A good reference for this is in Armand and Beverly Ball's book, Basic Camp Management (2004, p. 201). This is especially important when questions arise about decision making. Include a discussion about delegation, especially if health-care personnel will be working with tripping staff to deliver medications or cabin staff to deliver personal care to special needs campers.

Determine how and when health-care staff will communicate with other camp administrators. Is there a time each day when the camp director gets a summative report of who's been in the health center and for what reason? What incidents warrant immediate contact? This is also a good time to discuss confidentiality, especially regarding concerns that have safety implications for an individual or others, and a good time to remind health-care staff that they may not know everything about everyone.

Explain the difference between health services provided by the health center and those provided by other areas of camp. Sometimes health-care providers think they're the only ones with responsibility for health when, in most camps, this is a shared responsibility. Cabin counselors do their things, food service staff do theirs, maintenance has their role, activity staff do theirs, and the camp director has other aspects. Be sure health-care providers understand how they partner with a variety of people. Along with that understanding, talk with them about how and when to approach others when health needs must be addressed.

Explain the camp's Emergency Action Plan (EAP) and the health center's role in that plan. Emergencies are hot buttons for health-care staff. Many have anecdotally talked about not being able to sleep at night or enjoy their time-off because they "were sure something would happen." Often these folks simply need to understand that responding to an emergency triggers a response from a variety of people. Who are these folks and how is the team rehearsed? Explain what emergencies would trigger the EAP and how often the camp's had to use it.

If your health center staff provide orientation to other staff or campers, tell them when they'll be doing this and what content you want covered. Ask them what additional content they'd like to include.

Verify their understanding of your camp's medical protocols and health center policies. Talk through the variety of forms used to document various things. Talk about timeliness of charting; challenges with medication distribution; and how to access out-of-camp providers such as dentists, the clinic, or pharmacy. In describing these elements, also talk about communication with camper parents. Can health center staff simply initiate that on their own? Is such communication documented, where and how? How does communication about staff health differ from that done for campers?

Having this discussion does more than provide information. It also provides an opportunity to form a collaborative relationship between the professionals in the health center and those running the camp. Experienced camp directors tell stories about "how the camp nurse saved the day for us," but they also tell stories about "when it all went bad." In addition, one component of job satisfaction is matching employee job expectation with what the job really is. An orientation discussion that addresses these points goes far with establishing a strong baseline for the summer.

Orienting Staff to the Camp's Health Services

Getting staff pointed in the right direction sounds easy. They arrive bright eyed and bushy tailed, ready to take on anything campers would like. We do a great job talking with staff about camper needs and buoying their skills at facilitating the developmental tasks of campers. But we also need to address staff health needs — as employees. Staff members are not campers. And staff groups have their own health needs. Some arise from their own developmental tasks, and others are associated with simply being at a camp.

Let's talk a bit about those associated with being at camp. Risks common to staff, no matter what kind of camp, often include: (a) constant exposure to children; (b) a fairly programmed day; (c) limited access to communication with the outside world; (d) a significant change in privacy; and (e) the need to stick to camp procedures. These may sound benign but, over time, these can have a significant impact upon staff health — if not addressed early and assessed as the camp season unfolds. This introduces the domain of mental and emotional health, an area often neglected simply by oversight.

Being around children day in and day out can be wearing. Having a schedule that plots most moments of the day and steals "need to be alone" moments under the guise of "good supervision" elicits stress for most adults. Limiting contact with the world the person both came from and will go to after camp can also be stress-provoking, especially for people used to being "connected." Factor in our need for staff to follow procedures with their more natural tendency toward hubris, and it becomes apparent how being an adult at camp can be a challenge to one's health.

Strategies that address these risks are camp-specific. The point, however, is to recognize that the stressors exist. One can then talk with supervisors about intervention strategies as well as behaviors to monitor that indicate a particular person may be overwhelmed. One of my personal favorites is to watch who hangs out in the staff lounge and when. The place is often almost empty during the first week of camp but, as things get going and energy fatigues, more staff drift in more often. They no longer "hang out with the kids," but choose to crash in the staff lounge. If this sounds like your camp, try to determine why. Determining the reason often enables one to then craft a counter-strategy.

In addition to tackling mental and emotional health with staff, there are other components about staff health that we often forget to talk about. We remember the easy things: how to get medication, when the health center is open, what to do if a child wets his/her pants, their first response to an injury, attending to notes lovingly provided by parents to "my child's counselor". But what about the staff's ability to manage their personal health so they remain capable of doing the job? Is a statement of this ilk on the camp's personal performance forms? Acknowledging that it's a staff person's job to manage their personal health — not the camp's — allows staff to retain that responsibility. Asking them to talk with their supervisor, early on, when what the camp asks of them gets in the way of this opens the door to more effective communication (it may also indicate a point of intervention to the supervisor).

Staff members should also be oriented to their boundaries insofar as health care is concerned. Each of our camps has made certain promises to parents and medical protocols have been developed based on certain expectations, but when can a staff member initiate care for a camper's health need? A growing number of camps have developed a section in their staff manual to address this very thing and, because of challenges like the risk of blood exposure, have taken the position that staff are limited to coaching a camper in self-care to the level of the staff member's credential (what a person with basic first aid would coach differs from what the Wilderness First Responder might do). Other camp programs would consider such a statement too broad and may default to the old adage, "The first band-aid is first aid; anything after that gets referred."

Finally, there's more going on during health orientation for staff then just delivering content. Staff are also making judgments about how serious the camp takes health services as well as how approachable, how competent, and what kind of caring attitude is displayed by various people. An organized, informative session for staff goes a long way in communicating some of the more subtle aspects of the program. Attention to delivery style is well worth the effort!

Orienting Campers to Camp Health Services

Camps often formalize this by having the nurse talk to everyone on opening day; other programs have counselors deliver the message during cabin council or a similar meeting. It's the time when we tell campers about the health and safety issues that affect them. Just like the staff, campers also are making judgments about things that will impact them.

Readers who have listened to Marge Scanlin, executive officer, research/intellectual resources, talk about the research will recognize that some campers report feeling "not safe" while at camp. In spite of a camp's diligent work with EAPs, despite first-aid kits at all the right spots, regardless of buddy check and other such systems, kids are telling us that they don't feel safe. Some kids report wondering if people bring guns to camp, if someone will beat them up, if they'll be bullied, if the darkness at camp is concealing things in the bushes or if something is under the cabin and "might get me." Childhood fears are real to the child and may be based as much on imagination as anything else. Nonetheless, those fears should be addressed so the energy spent guarding is freed to enjoy camp.

This is a unique opportunity to add a dimension to your camp's health service program while improving the comfort of children at our camps. Consider the sociodemographic background of your campers. Ask what risks exist in their day-to-day world that are of concern to children. Kids from a city, for example, often report feeling uncomfortable with darkness. They're used to street lights. The sounds of their urban world are very different from what they hear outside the cabin at night. We teach our nation's children a set of survival skills appropriate to urban life: never go anywhere by yourself, don't talk to strangers, never take something from them, never undress in front of people you don't know, and if you're going someplace new, go with at least three other friends.

Then the kids come to camp, but no one tells them the rules have changed.

We need to address this.

Linda Ebner Erceg, R.N., M.S., P.H.N., is the health and safety coordinator for Concordia Language Villages and the executive director of the Association of Camp Nurses.